Preservative free travoprost and timolol fixed combination in the initial treatment of primary glaucoma: an assessment of hypotensive efficiency and safety

Purpose. To evaluate the efficacy and safety of Travapress Duo with respect to hypotensive results, changes in functional parameters, and adverse reactions. 
Material and methods. 30 patients aged 65–75 (averagely 71.3 ± 3.2 years) with a newly diagnosed primary open-angle glaucoma (POAG) received Travapress Duo in the evening, once a day. Goldman tonometry was performed during the screening, then 1 week, 1 month and 3 months from the treatment start. Static perimetry and optical coherence tomography (OCT) were performed before treatment and at the end of the 3rd month since the treatment start. Adverse events were recorded at each stage of the study.
Results. As a result of a 3 month long therapy with Travapress Duo, a significant decrease in IOP was noted starting from the 1st week of instillations (by 34 %), after 1 month, by 35 % and after 3 months of observation by 36 %. By the end of the 3rd month of treatment, we noted an insignificant increase in visual acuity, a positive dynamic of the standard deviation and the standard deviation pattern, as well as OCT indicators, such as average thickness of the layer of retinal nerve fibers and the layer of retinal ganglion cells in the macula, stabilization of the thickness of the retinal ganglion cell complex layer and the size of the inner plexiform layer. One patient complained of discomfort and hyperemia by the end of the 1st week of drug instillation. No systemic side effects were noted during the follow-up, and in no case drug withdrawal was require. 
Conclusion. The preservative-free Travapress Duo drug displayed a high hypotensive efficacy, reducing the IOP to 36% of the initial value. The hypotensive effect was accompanied by indirect neuroprotection, which manifested itself in the positive changes observable in the results of functional studies with varying degrees of reliability. Travapress Duo is characterized by a low level of local side effects and can be recommended for both for the initial and long-term therapy of primary glaucoma of developed and advanced stages.

1. Resnikoff S., Pascolini D., Etya'ale D., et al. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004; 82 (11): 844–51. doi:/S0042-96862004001100009

2. Bonomi L. Epidemiology of angle-closure glaucoma. Acta Ophthalmol. Scand. Suppl. 2002; 236: 11–13. doi:10.1034/j.1600-0420.80.s236.2.x

3. Tielsch J.M., Sommer A., Katz J., et al. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. 1991; 266 (3): 369–74.

4. European Glaucoma Society. Terminology and guidelines for glaucoma. 4th edition ed: Savona, Italy PubliComm; 2014.

5. Tham Y.C., Li X., Wong T.Y., et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014; 121 (11): 2081–90. doi:10.1016/j.ophtha.2014.05.013

6. Prum B.E., Jr., Rosenberg L.F., Gedde S.J., et al. Primary open-angle glaucoma preferred practice pattern(®) guidelines. Ophthalmology. 2016; 123 (1): 41–111. doi:10.1016/j.ophtha.2015.10.053

7. Li T., Lindsley K., Rouse B., et al. Comparative effectiveness of first-line medications for primary open-angle glaucoma: a systematic review and network meta-analysis. Ophthalmology. 2016; 123 (1): 129–40. doi:10.1016/j.ophtha.2015.09.005

8. McKee H.D., Gupta M.S., Ahad M.A., Saldana M., Innes J.R. First-choice treatment preferences for primary open-angle glaucoma in the United Kingdom. Eye (Lond). 2005; 19 (8): 923–4. doi:10.1038/sj.eye.6701674

9. Moore W., Nischal K.K. Pharmacologic management of glaucoma in childhood. Paediatr. Drugs. 2007; 9 (2): 71–9.

10. Quaranta L., Riva I., Katsanos A., et al. Safety and efficacy of travoprost solution for the treatment of elevated intraocular pressure. Clin. Ophthalmol. 2015; 9: 633–43. doi:10.2147/OPTH.S61444

11. Kass M.A., Heuer D.K., Higginbotham E.J., et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch. Ophthalmol. 2002; 120 (6): 701–13; discussion 829–30. doi:10.1001/archopht.120.6.701

12. Erb C., Gast U., Schremmer D. German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye. Graefes Arch. Clin. Exp. Ophthalmol. 2008; 246 (11): 1593–601. doi:10.1007/s00417-008-0881-9

13. Tsai J.C., McClure C.A., Ramos S.E., Schlundt D.G., Pichert J.W. Compliance barriers in glaucoma: a systematic classification. J. Glaucoma. 2003; 12 (5): 393–8. doi:10.1097/00061198-200310000-00001

14. Topouzis F., Melamed S., Danesh-Meyer H., et al. A 1-year study to compare the efficacy and safety of once-daily travoprost 0.004%/timolol 0.5% to once-daily latanoprost 0.005%/timolol 0.5% in patients with open-angle glaucoma or ocular hypertension. Eur. J. Ophthalmol. 2007; 17 (2): 183–90. doi:10.1177/112067210701700206

15. Hughes B.A., Bacharach J., Craven E.R., et al. A three-month, multicenter, double-masked study of the safety and efficacy of travoprost 0.004%/timolol 0.5% ophthalmic solution compared to travoprost 0.004% ophthalmic solution and timolol 0.5% dosed concomitantly in subjects with open angle glaucoma or ocular hypertension. J. Glaucoma. 2005; 14 (5): 392–9. doi:10.1097/01.ijg.0000176935.08392.14

16. Barnebey H.S., Orengo-Nania S., Flowers B.E., et al. The safety and efficacy of travoprost 0.004%/timolol 0.5% fixed combination ophthalmic solution. Am. J. Ophthalmol. 2005; 140 (1): 1–7. doi:10.1016/j.ajo.2005.02.043